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Background. The appropriate timing of rib fixation remains unclear. We investigated the efficacy of early rib fixation compared with late rib fixation, using data from a Japanese nationwide inpatient database.Methods. We identified patients who underwent rib fixation and received mechanical ventilation from July 1, 2010, to March 31, 2018, using data from the Diagnosis Procedure Combination database in Japan. The primary outcome was the duration of mechanical ventilation after rib fixation. Secondary outcomes were the length of hospital stay after rib fixation, total hospitalization costs, tracheostomy, pneumonia after admission, and all-cause 28-day in-hospital mortality. We performed propensity score-adjusted analyses to compare outcomes between patients undergoing rib fixation less than or equal to 6 days after admission and those undergoing rib fixation greater than 6 days after admission.

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Results: A total of 58 patients died (58%) out of 100 patients included in this study. Multivariate analysis revealed that age> 75 years (HR¼25.49, 95% CI¼2.36 to 275.66); GCS <9 (HR¼4.19, 95% CI¼1.58to 11.08); serum creatinine higher than 1.5 mg/ml (HR¼8.75; 95% CI¼3.10 to 24.71); PaCO2 >45mmHg (HR ¼14.86; 95% CI¼4.85 to 45.49) and history of cardiac diseases (HR¼0.37 95% CI¼0.15 to 0.91) were associated with high mortality rate. Conclusions: Age >75 years, GCS<9. PaCO2>45mmHg, serum creatinine exceeding 1.5 mg/ml and cardiac diseases are independent significant predictors of mortality in head trauma patients.